A black accordion file sits on a desk outside Mayor Thomas M. Menino’s empty office on the fifth floor of Boston City Hall. Most days, city employees stuff paper­work into manila folders in the compartments: One sleeve is reserved for documents Menino needs to sign, another for memos the mayor needs to read.

Normally, the bundle goes home with Menino to Readville. But for the past 25 days, the plastic file has been driven the 3½ miles from City Hall to Francis Street, where doctors at Brigham and Women’s Hospital continue to treat Menino for a ­variety of ailments.

The impersonal shuttling of documents to the Brigham — and verbal orders the mayor shares from his hospital bed through an inner circle of aides — has ­become the main link between Menino and roughly 20,000 city employees he has closely managed for almost 20 years. It marks a stark change for Menino, who so prides himself on personal connections that he has forbidden voicemail at City Hall.

Menino remained hospitalized Monday, with no significant update on his medical condition provided by his staff and no indication when he may be ­released. The initial illnesses — an upper respiratory infection and a blood clot that traveled from his leg to his lungs — have abated, doctors said last week. While in the hospital, Menino suffered a compression fracture in his spine.

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Doctors have said repeatedly that Menino’s mind remains sharp and that he is capable of making decisions appropriately. After five terms, Menino has built a sturdy administration that is keeping municipal government running without interruption, his staff has said, noting that the city has weathered two major storms, Hurricane Sandy and a subsequent nor’easter.

“The day-to-day stuff that our department heads do, they are going to keep doing that and doing it really well,” the mayor’s press secretary, Dot Joyce, said Monday from City Hall before leaving for the Brigham. “The things that the mayor needs to be involved in are the policy decisions. That’s what we’re focused on.”

In Menino’s hospital room, Joyce has been a consistent presence along with two of Menino’s other top aides: Mitchell Weiss, the chief of staff, and Michael Kineavy, the chief of policy and planning.

The three aides try to go as a team at least once a day to ­Francis Street. One usually grabs the black accordion file, which has been stuffed with ­labor contracts for nurses and teachers, new ordinances, and weekly financial documents that must be signed for the city to pay bills and make payroll deductions. Menino signs official documents while seated at a table or in his hospital bed, Joyce said.

While the mayor remains hospitalized, Weiss has presided over the administration’s weekly Cabinet meeting at 8:30 a.m. Wednesdays in the Eagle Room at City Hall, relaying questions and concerns from the boss to his 12 department heads.

According to Joyce, Menino has inquired about the search for a new headmaster for ­Madison Park High School, asked for detailed briefings about the effort to overhaul the city’s school assignment system, and urged city officials to make their annual push to help the homeless as the temperature drops.

He keeps two cellphones — one for city duties, one for campaign purposes — poised on a table next to his bed.

Other top city officials who are close to Menino have made repeated treks to the Brigham, including Police Commissioner Edward F. Davis. Early Monday morning, Davis made his fourth or fifth visit to the hospital and spent about 30 minutes with Menino. The commissioner said he briefed the mayor about an investigation into a ­recent sexual assault on Beacon Hill and spoke about a variety of other issues.

“We were talking about him getting out, which is a good sign,” Davis said later Monday in an interview. “Before, that topic wasn’t coming up.”

Doctors admitted Menino to the hospital Oct. 26 after he cut short what was supposed to be a two-week vacation in Italy. The trip and the hospital stay have taken the mayor out of the public eye for more than a month as he is considering running for a sixth term. While in the hospital, Menino has deposited almost $27,000 in contributions in his political account and his campaign spent more than $23,000 on food for a ­reception at the Boston Harbor Hotel, records show.

In the next month, Menino has several events that he may have to cancel, potentially limiting his profile. On Dec. 4, for example, he is slated to address the Greater Boston Chamber of Commerce at an event that has historically represented one of his three main policy addresses of the year.

“He has asked us about that [speech], and we haven’t made a decision,” Joyce said. “Presently, we’re talking to him about topics.”

Later in December, the city will hold its annual homeless census, which also has been an annual staple on the mayor’s calendar. Most years, Menino also leads a trolley tour to light neighborhood Christmas trees, a roving gala that he has always treasured as mayor.

Despite his prolonged hospital stay, Menino’s spirits remain good, said Barbara Ferrer, executive director of the Boston Public Health Commission, who spent time with him Friday and Sunday.

“He’s very alert. I don’t think people should have any concerns about whether he is focused on the business at hand — he’s very focused,” Ferrer said in an interview. “But he’s definitely tired and sick. It’s a needed hospitalization. He’s got a good team taking care of him. But he’s running the city.”